[40F] Experiencing cold extremities, severe brain fog, dizziness, and muscle fatigue

Patient Description

A 40-year-old female presents with a constellation of symptoms that have been developing over the past 4-5 months. The patient reports a persistent sensation of being cold, particularly in the hands and feet, accompanied by severe brain fog characterized by difficulty focusing, memory impairment, and trouble with complex tasks. The patient also experiences dizziness, described as lightheadedness with poor balance, which occurs upon transitioning from sitting or lying to standing and is sometimes followed by fainting. This dizziness is alleviated by laying down. Muscle fatigue in the arms and legs began approximately 3 days ago, with the patient feeling unusually tired and weak. The patient has a history of PCOS diagnosed in 2012, was formerly diabetic prior to gastric bypass surgery, and also has psoriasis and persistent skin discoloration. The patient suspects Ehlers-Danlos syndrome, but it remains unconfirmed. Current medications include omeprazole and various supplements such as passion flower, ginkgo, oat straw, dandelion root, ashwagandha, a multivitamin, and calcium. No known drug allergies are reported.

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Arora's Assessment

What might be happening

Based on the information you've provided, there are several possible explanations for your symptoms:

  • Postural Orthostatic Tachycardia Syndrome (POTS): This condition is characterized by an increased heart rate and lightheadedness or fainting upon standing. It can also cause symptoms like fatigue and brain fog. POTS is often associated with conditions like Ehlers-Danlos syndrome, which you suspect you may have.

    • Diagnosis typically involves a tilt table test or a standing test. Treatment usually involves lifestyle changes and medications to manage symptoms.
  • Iron Deficiency Anemia: This condition can cause symptoms like fatigue, cold hands and feet, paleness, and dizziness. It can be more common in people who have had gastric bypass surgery, as this can affect the body's ability to absorb iron.

    • Diagnosis typically involves blood tests. Treatment usually involves iron supplements and dietary changes.
  • Hypothyroidism: This condition can cause symptoms like fatigue, cold sensitivity, and cognitive issues. It can be more common in people with other autoimmune conditions, like psoriasis.

    • Diagnosis typically involves blood tests. Treatment usually involves hormone replacement therapy.
  • Vitamin B12 Deficiency: This condition can cause symptoms like fatigue, cognitive issues, and dizziness. It can be more common in people who have had gastric bypass surgery, as this can affect the body's ability to absorb vitamin B12.

    • Diagnosis typically involves blood tests. Treatment usually involves B12 supplements or injections.

Please note that these are possibilities based on your symptoms and not a definitive diagnosis. You should seek care from a healthcare professional to receive a formal diagnosis and treatment.

What you can do

In the meantime, you can try the following to manage your symptoms:

  1. Stay hydrated and maintain a balanced diet. This can help manage symptoms like dizziness and fatigue.
  2. Try to get up slowly from a sitting or lying position. This can help manage symptoms of lightheadedness.
  3. Keep a symptom diary. Note down when your symptoms occur, what you're doing at the time, and anything that makes them better or worse. This can be helpful information for your doctor.

What you should look out for

You should seek immediate medical attention if you experience:

  • Severe dizziness or fainting
  • Chest pain or difficulty breathing
  • Severe weakness or difficulty moving
  • Any other severe or concerning symptoms

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

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1 yr ago

Top picked over-the-counter products for POTS: Heart Rhythm Society Treatment Consensus

People Also Ask


What is Postural Orthostatic Tachycardia Syndrome (POTS) and how is it diagnosed?

Postural Orthostatic Tachycardia Syndrome (POTS) is a condition characterized by an abnormal increase in heart rate when transitioning from lying down to standing, often accompanied by symptoms like dizziness, lightheadedness, and fatigue. It is diagnosed through tests such as a tilt table test or a standing test, which measure heart rate and blood pressure changes upon standing.


How can iron deficiency anemia affect someone who has had gastric bypass surgery?

Iron deficiency anemia can occur after gastric bypass surgery because the surgery can affect the body's ability to absorb iron from food. This can lead to symptoms like fatigue, cold extremities, paleness, and dizziness. Diagnosis is typically made through blood tests, and treatment involves iron supplements and dietary adjustments.


What are the common symptoms of hypothyroidism and how is it treated?

Common symptoms of hypothyroidism include fatigue, sensitivity to cold, weight gain, and cognitive issues such as brain fog. It is diagnosed through blood tests that measure thyroid hormone levels. Treatment usually involves hormone replacement therapy to restore normal hormone levels.


Why might someone who has had gastric bypass surgery be at risk for vitamin B12 deficiency?

After gastric bypass surgery, the body's ability to absorb vitamin B12 can be impaired due to changes in the digestive system. This can lead to a deficiency, causing symptoms like fatigue, cognitive issues, and dizziness. Diagnosis is made through blood tests, and treatment typically involves B12 supplements or injections.


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